Applications are accepted until all 5 scholarships have been granted within a calendar year.

Application for scholarship must include:
(1) A completed FBHA Scholarship Application form.
(2) A brief essay (no more than 500 words typed), prepared by the applicant, on the following topic:

Having had a suicide impact your family, how would you use your experience to promote prevention and awareness to others?

SELECTION CRITERIA
Applicants will be assessed and awards granted based on the following criteria:
(1) All information provided in application.
(2) The thoughtfulness of the applicant’s essay and its relevance to the topic.
(3) Additonal information, such as college enrollment documentation, grades, etc.

Application

Firefighter Behavioral Health Alliance Scholarship Program

First and Last Name*

Street Address*

City*

State*

Zip*

Contact Phone*

Email*

Age*

Name of relative that passed away*

Relationship*

Type (Career/Part Time/Paid On Call/Volunteer)*

Rank*

Name of HS or College you are currently attending*

Address of HS or College you are currently attending*

GPA*

Name of University, College or School of Higher Learning that you are planning on attending*

Address of University, College or School of Higher Learning that you are planning on attending*

Applicant to write a brief essay of 500 words or less on the topic: Having had a suicide impact your family, how would you use your experience to promote prevention and awareness to others?*

Additional comments or questions?*

1,279
FF 14
EMS 3

Confidential Firefighter Suicide Report

In order for FBHA to be able to serve the needs of the fire service family, the more information we can gather on the firefighter suicide mechanism for pro-active training, the better. By gathering as much information as we can, we can provide a profile that helps identify at-risk firefighters before this tragedy strikes. This information has proven to be an invaluable tool for the police service.
We request that anyone having information on a firefighter suicide please contact FBHA using the form below. Because we are mindful that some agencies prohibit the release of information by their Departments, and that some family members may not be aware that there is a way to make notifications, we have developed a "blind form" that assists in providing anonymity for the submitting party. This form has been graciously given to FBHA to use from Robert E. Douglas, Jr. of the National P.O.L.I.C.E. Suicide Foundation. Once you submit this confidential form, it is transmitted to Firefighter Behavioral Health Alliance's email, with the sender information removed. Since we have no means to contact the submitter back because that information is blocked, we appreciate as much information as you can provide. FBHA then uses this information to keep its training pro-active and post-event, current.
At a minimum, we require the agency's name, state, firefighter's sex, rank, years of service, date of death, how death occurred, and any stressors identified or suspected as being a catalyst. We would appreciate any additional information or details that can be provided.
It is FBHA's policy not to release firefighter or department specific information. We respect the privacy of the families and agencies involved. It is not our intention to cause any undue pain to families or agencies. Additionally, we do not release this specific case information to the media.
Sincerely,
Jeff Dill
Founder
Firefighter Behavioral Health Alliance